Long-term Care Quality and Modernization Act of 2006 - Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Secretary Act to require states to establish a process for joint training and education for nursing home surveyors and providers at least annually as changes to regulations, guidelines, and policy governing nursing facility operations are implemented. Requires individuals newly hired as surveyors to be assigned full-time to a nursing facility to observe actual operations outside of the survey process before the individuals begins oversight responsibilities.
Sets forth provisions related to resumption of nursing aid training program for skilled nursing facilities after correction of deficiencies.
Permits: (1) split or shared Medicare billing by physicians and nurse practitioners in such facilities; and (2) nurse practitioners employed by such facilities to certify skilled care under Medicaid.
Directs the Secretary of Health and Human Services to: (1) establish a condition-based system of physical therapy services based on medical necessity; and (2) utilize an area wage index for such facilities based on wage data from such facilities and not from hospitals to determine a federal per diem for such facilities.
Authorizes the Secretary to exclude from the Medicare prospective payment system for such facilities: (1) high cost and low probability cancer treatment drugs; (2) all ambulance services; and (3) additional items and services that the Secretary determines to be appropriate.
Eliminates the hospital stay requirement for coverage of extended care services under Medicare.
Amends the Public Health Service Act to require the Secretary to establish a national nursing database to be used to predict future nursing shortages.
Amends the Internal Revenue Code to provide for a 10-year recovery period for qualified long-term care improvement property.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6199 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 6199
To improve the quality of, and access to, long-term care.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 27, 2006
Ms. Ginny Brown-Waite of Florida (for herself and Mr. Camp) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Energy and Commerce, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To improve the quality of, and access to, long-term care.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Long-term Care
Quality and Modernization Act of 2006''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE AND MEDICAID MODERNIZATION
Sec. 101. Joint training of surveyors and providers.
Sec. 102. Facility-based training for new surveyors.
Sec. 103. Resumption of nurse aide training program after correction of
deficiencies.
Sec. 104. Clarifying and eliminating the distinction between physician
supervision requirements for skilled
nursing facilities and nursing facilities.
Sec. 105. Permitting split or shared billing by physicians and nurse
practitioners in skilled nursing
facilities.
Sec. 106. Permitting nurse practitioners employed by skilled nursing
facilities to certify skilled care.
Sec. 107. Modernization of therapy caps.
Sec. 108. Establishment of a Medicare skilled nursing facility specific
wage index.
Sec. 109. Authority to exclude high cost and low probability drugs used
in the treatment of cancer from the
Medicare prospective payment system for
skilled nursing facilities.
Sec. 110. Exclusion of all ambulance services from the Medicare
prospective payment system for skilled
nursing facilities.
Sec. 111. Authority to exclude additional items and services from the
Medicare prospective payment system for
skilled nursing facilities.
Sec. 112. Elimination of Medicare 3-day post-hospital stay requirement
for coverage of skilled nursing facility
services.
TITLE II--WORKFORCE SUPPORT
Sec. 201. Nursing loan repayment program.
Sec. 202. National nursing database.
Sec. 203. Reports on nursing levels.
TITLE III--TAX INCENTIVES
Sec. 301. 10-year recovery period for qualified long-term care
improvement property.
TITLE I--MEDICARE AND MEDICAID MODERNIZATION
SEC. 101. JOINT TRAINING OF SURVEYORS AND PROVIDERS.
(a) Medicare Program.--Section 1819(e) of the Social Security Act
(42 U.S.C. 1395i-3(e)) is amended by adding at the end the following
new paragraph:
``(6) Joint surveyor/provider training.--The Secretary
shall require the State to establish a process for joint
training and education of surveyors and providers at least
annually and periodically as changes to regulations,
guidelines, and policy governing nursing facility operations
are implemented and used in surveys of participating
facilities.''.
(b) Medicaid Program.--Section 1919(e) of the Social Security Act
(42 U.S.C. 1396r(e)) is amended by adding at the end the following new
paragraph:
``(8) Joint surveyor/provider training.--The State shall
establish a process for joint training and education to
surveyors and providers at least annually and periodically as
changes to regulations, guidelines, and policy governing
nursing facility operations are implemented and used in surveys
of participating facilities.''
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2007.
SEC. 102. FACILITY-BASED TRAINING FOR NEW SURVEYORS.
(a) Medicare Program.--Section 1819(e) of the Social Security Act
(42 U.S.C. 1395i-3(e)), as amended by section 101(a), is amended by
adding at the end the following new paragraph:
``(7) Facility-based training for new surveyors.--The
Secretary shall require the State to establish a process for
assuring that--
``(A) each individual newly hired as a nursing home
surveyor, as part of the individual's basic training,
is assigned full-time to a participating nursing
facility for at least 5 days within a 7-day period to
observe actual operations outside of the survey process
before the individual begins oversight
responsibilities;
``(B) such individual shall not assume oversight
responsibility during this training period and such
observations may not be the sole basis of a deficiency
citation against the facility; and
``(C) such individual shall not be assigned as a
member of a survey team for the facility in which the
individual received training for two standard surveys
following the training period in the facility.''.
(b) Medicaid Program.--Section 1919(e) of the Social Security Act
(42 U.S.C. 1396r(e)), as amended by section 101(b), is amended by
adding at the end the following new paragraph:
``(9) Facility-based training for new surveyors.--The State
shall establish a process for assuring that--
``(A) each individual newly hired as a nursing home
surveyor, as part of the individual's basic training,
is assigned full-time to a participating nursing
facility for at least 5 days within a 7-day period to
observe actual operations outside of the survey process
before the individual begins oversight
responsibilities;
``(B) such individual shall not assume oversight
responsibility during this training period and such
observations may not be the sole basis of a deficiency
citation against the facility; and
``(C) such individual shall not be assigned as a
member of a survey team for the facility in which the
individual received training for two standard surveys
following the training period in the facility.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2007.
SEC. 103. RESUMPTION OF NURSE AIDE TRAINING PROGRAM AFTER CORRECTION OF
DEFICIENCIES.
(a) Resumption of Nurse Aide Training Program for Skilled Nursing
Facilities.--Section 1819(f)(2) of the Social Security Act (42 U.S.C.
1395i-3(f)(2)) is amended--
(1) in paragraph (B)(iii), in the matter preceding
subclause (I), by striking ``(C) and (D)'' and inserting ``(C),
(D), and (E)''; and
(2) by adding at the end the following new subparagraph:
``(E) Resumption of nurse aide training program
after correction of deficiencies.--Clause (iii)(I) of
subparagraph (B) shall not apply to a program offered
by or in a skilled nursing facility if the facility
has--
``(i) corrected any deficiencies that
resulted in the prohibition of approval of such
program; and
``(ii) demonstrated compliance with the
requirements of subsections (b), (c), and (d)
of this section.''.
(b) Resumption of Nurse Aide Training Program for Nursing
Facilities.--Section 1919(f)(2) of the Social Security Act (42 U.S.C.
1396r(f)(2)) is amended--
(1) in paragraph (B)(iii), in the matter preceding
subclause (I), by striking ``(C) and (D)'' and inserting ``(C),
(D), and (E)''; and
(2) by adding at the end the following new subparagraph:
``(E) Resumption of nurse aide training program
after correction of deficiencies.--Clause (iii)(I) of
subparagraph (B) shall not apply to a program offered
by or in a nursing facility if the facility has--
``(i) corrected any deficiencies that
resulted in the prohibition of approval of such
program; and
``(ii) been determined to be in compliance
with the requirements of subsections (b), (c),
and (d) of this section.''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2007.
SEC. 104. CLARIFYING AND ELIMINATING THE DISTINCTION BETWEEN PHYSICIAN
SUPERVISION REQUIREMENTS FOR SKILLED NURSING FACILITIES
AND NURSING FACILITIES.
(a) Physician Supervision Requirements for Skilled Nursing
Facilities.--Section 1819(b)(6)(A) of the Social Security Act (42
U.S.C. 1395i-3(b)(6)(A)) is amended by inserting ``(or, at the option
of a State, under the supervision of a nurse practitioner, clinical
nurse specialist, or physician assistant who is working in
collaboration with a physician)'' before the semicolon at the end.
(b) Clarifying Physician Supervision Requirements for Nursing
Facilities.--Section 1919(b)(6)(A) of the Social Security Act (42
U.S.C. 1396r(b)(6)(A)) is amended by striking ``who is not an employee
of the facility but''.
(c) Effective Date.--The amendments made by this section shall take
effect on January 1, 2007.
SEC. 105. PERMITTING SPLIT OR SHARED BILLING BY PHYSICIANS AND NURSE
PRACTITIONERS IN SKILLED NURSING FACILITIES.
(a) In General.--Section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)) is amended by adding at the end the following new
paragraph:
``(13) Permitting split or shared billing by physicians and
nurse practitioners in skilled nursing facilities.--
Notwithstanding section 1861(s)(2)(K)(ii), a physician and a
nurse practitioner may each submit a claim for payment for
their portion of a service provided to a resident of a skilled
nursing facility, except that, in no case may the total amount
paid under this title be greater than it would have been if
only one person had submitted a claim for such service.''.
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2007.
SEC. 106. PERMITTING NURSE PRACTITIONERS EMPLOYED BY SKILLED NURSING
FACILITIES TO CERTIFY SKILLED CARE.
(a) In General.--Section 1814(a)(2) of the Social Security Act (42
U.S.C. 1395f(a)(2)) is amended by striking ``or a nurse practitioner
or'' and inserting ``a nurse practitioner, or a''.
(b) Effective Date.--The amendment made by this section shall take
effect on January 1, 2007.
SEC. 107. MODERNIZATION OF THERAPY CAPS.
Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is
amended--
(1) in paragraph (4)--
(A) by striking ``This subsection'' and inserting
``Except as provided in paragraph (6), this
subsection''; and
(B) by inserting ``and with respect to services
furnished on or after January 1, 2009'' before the
period at the end; and
(2) by adding at the end the following new paragraph:
``(6) In the case of services described in paragraph (1),
with respect to such services furnished on or after January 1,
2009, the Secretary shall establish and implement a condition-
based system based on medical necessity for necessary and
clinically appropriate services. Such system shall utilize a
standardized patient assessment tool to evaluate the level of
such services that are needed by an individual and impose a
limitation on coverage of such services under this part based
on such tool.''.
SEC. 108. ESTABLISHMENT OF A MEDICARE SKILLED NURSING FACILITY SPECIFIC
WAGE INDEX.
Section 1888(e)(4)(G)(ii) of the Social Security Act (42 U.S.C.
1395yy(e)(4)(G)(ii)) is amended by inserting after the first sentence
the following new sentence: ``For services furnished on or after
October 1, 2008, in making the adjustment under the preceding sentence,
the Secretary shall utilize an area wage index for skilled nursing
facilities based on wage data from such facilities and not from
hospitals.''
SEC. 109. AUTHORITY TO EXCLUDE HIGH COST AND LOW PROBABILITY DRUGS USED
IN THE TREATMENT OF CANCER FROM THE MEDICARE PROSPECTIVE
PAYMENT SYSTEM FOR SKILLED NURSING FACILITIES.
(a) In General.--Section 1888(e)(2)(A)(iii) of the Social Security
Act (42 U.S.C. 1395yy(e)(2)(A)(iii)) is amended--
(1) by redesignating subclauses (IV) and (V) as subclauses
(V) and (VI), respectively; and
(2) by inserting after subclause (III) the following new
subclause:
``(IV) Any drugs (not otherwise
described in subclause (II)) used in
the treatment of cancer, including
antineoplastic drugs, antiemetics, and
supportive medications, that the
Secretary determines to be
appropriate.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to drugs furnished on or after October 1, 2007.
SEC. 110. EXCLUSION OF ALL AMBULANCE SERVICES FROM THE MEDICARE
PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NURSING
FACILITIES.
(a) In General.--Section 1888(e)(2)(A)(iii)(I) of the Social
Security Act (42 U.S.C. 1395yy(e)(2)(A)(iii)(I)) is amended by striking
``furnished to'' and all that follows before the period.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to services furnished on or after October 1, 2007.
SEC. 111. AUTHORITY TO EXCLUDE ADDITIONAL ITEMS AND SERVICES FROM THE
MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR SKILLED NURSING
FACILITIES.
(a) Authority.--Section 1888(e)(2)(A) of the Social Security Act
(42 U.S.C. 1395yy(e)(2)(A)) is amended--
(1) in clause (i)(II), by striking ``and (iv)'' and
inserting ``(iv), and (v)(I)''; and
(2) by adding at the end the following new clause:
``(v) Exclusion of additional items and
services determined appropriate by the
secretary.--
``(I) In general.--Items and
services described in this clause are
any items and services not otherwise
described in clauses (ii), (iii), or
(iv), that the Secretary determines to
be appropriate.
``(II) Annual update.--The
Secretary shall annually update the
items and services described in
subclause (I) to take into account
changes in the practice of medicine.''.
(b) Clarification.--Items and services described in section
1888(e)(2)(A)(v)(I) of the Social Security Act (42 U.S.C.
1395yy(e)(2)(A)(v)(I)), as added by subsection (a), may include items
and services furnished in a freestanding clinic to an individual who is
a resident of a skilled nursing facility.
(c) Effective Date.--The amendment made by subsection (a) shall
take effect on October 1, 2007.
SEC. 112. ELIMINATION OF MEDICARE 3-DAY POST-HOSPITAL STAY REQUIREMENT
FOR COVERAGE OF SKILLED NURSING FACILITY SERVICES.
(a) In General.--Section 1812(a)(2) of the Social Security Act (42
U.S.C. 1395d(a)(2)) is amended--
(1) by striking ``(A) post-hospital'' and
(2) by striking ``, and (B)'' and all that follows up to
the period at the end.
(b) Conforming Amendments.--
(1) Title XVIII of the Social Security Act are each amended
by striking ``post-hospital'' before ``extended care services''
each place it appears.
(2) Section 1812(f) of such Act is repealed.
(3) Section 1861(i) of such Act is repealed.
(4) Section 1888(e)(2)(A)(i)(I) of such Act is amended by
striking ``section 1861(i)'' and inserting ``section 1861(h)''.
(c) Effective Date.--The amendments made by this section shall
apply to extended care services furnished in periods of stay beginning
on or after January 1, 2007.
TITLE II--WORKFORCE SUPPORT
SEC. 201. NURSING LOAN REPAYMENT PROGRAM.
Section 846(a) of the Public Health Service Act (42 U.S.C. 297n(a))
is amended by striking the last sentence.
SEC. 202. NATIONAL NURSING DATABASE.
(a) In General.--The Secretary of Health and Human Services shall
provide for the establishment of a national nursing database to be used
to predict future nursing shortages.
(b) Information in Database.--The database established under
subsection (a) shall be designed to include nursing workforce data
across all healthcare provider settings, including nursing educators,
as determined by the Secretary of Health and Human Services to be
appropriate for use in the analysis of trends in the supply and demand
of nurses and to create an educational model to predict future nursing
workforce needs.
(c) Funding.--The Secretary of Health and Human Services may
transfer, from amounts appropriated for the National Center for Health
Workforce Analysis, such sums as may be necessary to carry out this
section.
SEC. 203. REPORTS ON NURSING LEVELS.
Section 806 of the Public Health Service Act (42 U.S.C. 296e), as
amended by section 202, is further amended by adding at the end the
following:
``(j) Reports Concerning Nursing Levels.--
``(1) In general.--The entities described in paragraph (2)
shall annually submit to the Secretary a report concerning how
assistance under this title is being used by such entities to
increase the number of nurses, nursing educators, and nurse
education enrollment slots.
``(2) Entities described.--An entity is described in this
paragraph if such entity is--
``(A) an entity that receives a grant or contract
under this title;
``(B) a school of nursing that receives student
loan funds under this title;
``(C) a school of nursing that receives nurse
faculty student loan funds under this title; and
``(D) any other entity that receives assistance
under this title.''.
TITLE III--TAX INCENTIVES
SEC. 301. 10-YEAR RECOVERY PERIOD FOR QUALIFIED LONG-TERM CARE
IMPROVEMENT PROPERTY.
(a) In General.--Subparagraph (D) of section 168(e)(3) of the
Internal Revenue Code of 1986 (relating to 10-year property) is amended
by striking ``and'' at the end of clause (i), by striking the period at
the end of clause (ii) and inserting ``, and'', and by adding at the
end the following new clause:
``(iii) any qualified long-term care
improvement property.''.
(b) Qualified Long-Term Care Improvement Property.--Section 168(e)
of the Internal Revenue Code of 1986 (relating to classification of
property) is amended by adding at the end the following new paragraph:
``(8) Qualified long-term care improvement property.--The
term `qualified long-term care improvement property' means any
section 1250 property which is an improvement to a building
if--
``(A) such improvement is placed in service more
than 3 years after the date such building was first
placed in service, and
``(B) such building is, or is a part of, a nursing
facility, assisted living facility, residential care
facility, intermediate care facility for the mentally
retarded, or similar facility designed to provide
housing and healthcare for the elderly and disabled.''.
(c) Alternative System.--The table contained in section
168(g)(3)(B) of the Internal Revenue Code of 1986 (relating to special
rule for certain property assigned to classes) is amended by inserting
after the item relating to subparagraph (D)(ii) the following:
``(D)(iii).......... 10''.
(d) Effective Date.--The amendments made by this section shall
apply to property placed in service after the date of the enactment of
this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman .
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